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ILCA 2023 Conference Presentation: Building Policy Coalitions

ILCA 2023 Conference Presentation –Building Policy Coalitions: A Case Study of Reframing Breastfeeding Around ‘First Food Security’ in Australia  Presenters: Naomi Hull and Libby Salmon Report complied by: Caoimhe Whelan
Conference Photo 2023

One of my favourite live presentations at the ILCA 2023 Conference in Las Vegas was one by two Australian presenters, Naomi Hull and Libby Salmon, which explored the idea of reframing breastfeeding in the context of ‘First Food Security’ in Australia. Naomi is an IBCLC and volunteer peer counsellor with the Australian Breastfeeding Association (ABA), and has a background in infant feeding policy, research and health promotion. She is also the Australian coordinator for the World Breastfeeding Trends Initiative Assessment (WBTi-Aus). Libby is a PhD candidate at the Australian National University researching the issue of food security for infants and young children as workforce participation by mothers and markets for human milk expand, and supplies of infant formula face unprecedented global demand. Libby is also a volunteer peer counsellor with the ABA and is involved with WBTi-Aus.

The presentation took place after lunch on the second day of the conference, and despite the combined effect of jetlag and a post-lunch energy-slump, Naomi and Libby held my interest, kept me awake, and provided me with many interesting insights into breastfeeding policy in Australia and the notion of reframing breastfeeding as a first food security issue.

Naomi started the presentation by providing us with some context. She provided statistics on breastfeeding in Australia – an initiation rate of 96%, exclusive breastfeeding rate of 15% at 5 months, and 20% of babies still breastfeeding at 12 months. However, these figures are from 2010 and Naomi informed us that Australia currently has no national breastfeeding strategy, no national coordinating committee, no targets and no up-to-date data. Naomi went on to describe some of the consequences of a lack of funding and national breastfeeding policy, such as a lack of emergency planning and preparedness for infant and young child feeding in the event of bushfires. Australia experienced bushfires in 2019 and floods in 2022 and some families found themselves in situations where they were seeking shelter, with no access to facilities to prepare infant formula or access family-centred support. Large amounts of formula were donated in an uncoordinated fashion, but often it went out of date before it was used, or was for infants over twelve months of age.

Naomi went on to explore why health systems fail breastfeeding and fail families like those affected by natural disasters in Australia. She focused on Australia’s interests in commercial milk formula (CMF) and how the powerful infant feeding lobby has managed to influence policies on formula marketing, export and manufacture. Much like the Irish government, the Australian government subsidises the CMF industry and in doing do, “puts babies before bottom lines”.  However, there are many non-governmental organisations in Australia who have joined forces to form a coalition that aims to counter the influence on government and policy by the CMF industry. This coalition includes the ABA, WBTi-Aus, the Public Health Association of Australia, the Australian College of Midwives, Lactation Consultants of Australia and New Zealand, and academic institutions. The main goal of coming together as a coalition is to get the members to consider the collective knowledge and skills they can use to help shape breastfeeding policy and planning in Australia, and in effect to have members ‘singing off the same hymn sheet’. Naomi concluded her part of the presentation by encouraging all those in attendance to consider who their local coalition members might be (eg here in Ireland we have ALCI, Cuidiu, La Leche League, academics, researchers etc), and how they might be better able to work together to influence policy and fund research that will result in achieving our breastfeeding targets or as she put it, our “breastfeeding utopia”.

Libby presented for the second half of the session and started off by defining the term ‘first food security’ as “when all people at all times have physical, social and economic access to sufficient, safe and nutritious food…” (Food and Agriculture Organisation, 1996). When framed in this context, breastmilk becomes a critical universally available first food for infants and young children, and a “sustainable, localised food system”. However, this breastmilk food chain is vulnerable to disruption if it is not protected, promoted and supported, and grounded in women’s and children’s rights to breastfeed. Libby described some of the situations and contexts which can threaten the security of breast milk as a first food; infant formula marketing, and structural failures such as lack of paid maternity leave and sociocultural factors. One point she made really resonated strongly with me, that of the ‘breastfeeding paradox’ – that the poorest households are the least likely to breastfeed. This is particularly true here in Ireland and has been previously highlighted by the ESRI Growing up in Ireland study.

So, how can the concept of first food security be used as an advocacy tool for breastfeeding? Libby outlined a number of ways in which this can be done, first and foremost by reframing the protection of breastfeeding first food security from optional to critical. She also suggested that breastfeeding is discussed in policy forums other than that of maternal health, such as disaster planning and farming, and that focusing on the first food security messaging has the potential to disrupt CMF marketing messages. Breastfeeding is not just a women’s health issue. Infant feeding is not just about a choice that parents make. Breastfeeding has to be considered in the context of climate change, structural barriers, rights, and food security and must be regarded as a solution. In an Irish context then, we should be looking at which population groups or demographic areas are vulnerable, and what needs to happen (policy changes, initiatives etc) to provide them with the supports they need to reduce those vulnerabilities.

Libby described efforts that a coalition of organisations including the ABA, Infant and Young Child Feeding in Emergencies (IYCF-E) and Food Systems Policy (Deakin University) put into creating a submission to an Australian Government inquiry on food security that was initiated in 2022. The submission defined breastfeeding women as “primary producers” and highlighted the value of breastfeeding to the economy. It also stressed the importance of paid parental leave in protecting breastfeeding, the resilience of breastfeeding as a food source during emergencies and the importance of breastfeeding in mitigating the effects of climate change. The submission was initially rejected by the inquiry and it was only after sustained lobbying of members of parliament and the government agriculture committee that the submission was finally accepted.

To conclude her presentation, Libby outlined recommendations for how breastfeeding organisations in other countries should advocate for first food security. The first step is to define first food security in emergency and everyday contexts, the second is to identify coalition members, the third is to identify a clear message/asks and political opportunities,  and the fourth is to develop a strategy that will allow for opposition, engage coalitions and get breastfeeding on the right agendas.

Both Australia and Ireland have big dairy farming and CMF manufacturing industries. So, there may be a lot of key learnings from our colleagues in Australia on how they reframed breastfeeding as a first food security issue and managed to push back against the power of CMF industry marketing and lobbying. Is there anything we need to be doing differently in Ireland to ensure that breastfeeding is being taken seriously, not just as a women’s health issue, but as something that is critical to ensure first food security and mitigate against the effects of climate change? Do we need to build an Irish Breastfeeding Coalition?!

Report complied by: Caoimhe Whelan

Dated: 1st September, 2023

Caoimhe received a bursary of €300 from ALCI to attend the ILCA Conference, which was held in Las Vegas.

ALCI Council would like to thank you for this report.